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Although this contributes to the existing literature, the
study sample limits the generalizability of the results and the
analyses that could be conducted on the data. The sample was
primarily White, well educated, and of a high socioeconomic
status. Also, despite recruitment efforts to the contrary, the study
sample was relatively active, and it clearly overrepresented the
action-oriented stages of exercise behavior change. This limited
the ability of this study to test the stage-matched intervention
against a standard care intervention across the full range of the
stages of change. There were simply too few individuals in the
early stages of exercise behavior change to conduct reasonable
analyses, a result that has plagued many studies of transtheo-
retically based interventions (e.g., 16). The attrition rate of 32%
is also problematic; however, the study participants did have to
complete a large number of questionnaires for only the chance
of some compensation. Fortunately, those individuals that com-
pleted the intervention did not differ from those that dropped out
in any of the initial baseline measures. In another similar
worksite intervention, Marcus et al. (17) had only 58% of their
original sample complete a 3-month intervention using printed
intervention materials. More research is required to determine
how to encourage greater participation and completion rates as
we attempt to move from efficacy to feasibility studies.
A number of findings in this study raise further questions
that will require empirical evaluation. Although this study does
begin to offer some support for the view that exercise stages are
viable entities, further study is necessary to definitively answer
the question of whether exercise stages exist. Particularly,
studies that include greater numbers of individuals at the
precontemplation, contemplation, and preparation stages are re-
quired. Recruitment of those individuals is unfortunately the
most difficult; therefore, specific strategies need to be developed
and used to facilitate their recruitment. This may require using
random-digit dialing techniques with a set recruitment goal for
individuals in the preaction stages.
Overall, this study does demonstrate the utility of the
Transtheoretical Model in the development of personalized,
stage-targeted interventions. Future investigations may wish to
examine interventions that are tailored to the full set of
Transtheoretical Model measures including processes of
change, decisional balance, and confidence versus this simpler,
stage-targeted intervention to help determine the optimal level
of tailoring.
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